KEY HOARDING MESSAGES• Hoarding is found in all cultures, genders, income and education levels and for different reasons.• Hoarding interventions are usually complicated, costly and time consuming• Hoarding situations continue to deteriorate until the health and safety of the individual and community are put at risk
HOARDING IS:•• A symptom of Obsessive Compulsive Disorder (OCD and OCDP).• Defined as the acquisition of, and failure to discard, possessions that appear to be useless or of limited value (Frost and Gross, 1993)• Activities of daily life are impaired by spaces which cannot be used for intended use.• Distress or impairment in functioning to the person hoarding or others
HOARDING vs. CLUTTERINGHoarding and cluttering are often usedinterchangeably. There are twodifferences:1. Clutterers can discard things moreeasily2. Their clutter does not debilitate theirlives to the same degree
CHARACTERISTICS OF HOARDERS• Need for control, no one can move possessions• Discarding is laborious and distressing; so it is avoided• Categorization Problems- difficulty differentiating between what is valuable and what is not
KEY PRESENTATION MESSAGE2 Essentials for Success:1. Getting people help with the reasonsthey hoard2. Cleaning up the property which is theby product of the untreated behavior
TYPES OF HOARDING• Common Hoarding - Generalist - Specialist• DiogenesSyndrome• Animal Hoarding
COMMON HOARDING• Anything can be Hoarded; most often items are what most people save• Insight is limited- they ignore the impact their behavior has on themselves and others• Generalists-- save everything from human waste to valuable items• Specialists-- save one or more specific categories of items
DIOGENES SYNDROME• Self-Neglect-- lack of clothing, poor nutrition, medical and dental care even when they can afford it• Domestic Squalor-- makes residence unhealthy• Hoarding-- makes residence unsafe
Characteristics of Diogenes Syndrome1. Lives alone2. Above average intelligence3. Reclusive, suspicious, obstinate, isolated from potential sources of support.4. Men and women are equally at risk
Characteristics contd• Approximately 40% of those affected also have significant psychopathology• Severe situations are often accompanied by physical health problems• Correlated with Age
Better Outcomes• Day Programs supplemented by Community Care services• Have support of a "trusting relationship" such as a caregiver, social worker, psychologist or case manager.
ANIMAL HOARDINGAccumulation of animals to theextent that:• Failure to provide minimal nutrition, sanitation and veterinary care• Failure to act on the deteriorating condition of the animals or the environment• Failure to act on or recognize the negative impact of the collection on their own
ANIMAL HOARDINGcontd• Prevalence is estimated at 88/100,000 GP• The most difficult to treat usually claiming to be pet rescuers• Where animal neglect and abuse are suspected, also assess for child & elder neglect and abuse if either co-reside
Hoarding is associated with other Axis I Disorders• Depression• Anxiety Disorders• Eating Disorders• Addictions (drugs, alcohol, gambling)• Tics, Tourettes Syndrome• Autism• Schizophrenia• Dementia
What Works?• Medication alone has little effect on Hoarding• In-Home support• "Collaborative Intervention"• Multimodal--Combination of medication, therapy and increased social contact
Hoarding Cleanup InterventionsSTEP: 11. Assess the risk and respond accordingly: o Risk to the resident o Risk to the other residents o Risk to the "responders"
STEP: 2Hoarding situations need a team1. Who is your team2. Which organizations do you need on your team to get the job done on time?3. Whats the "Team Plan" -- "How can we make it happen" approach
STEP: 31. Control your reactions to the sight and smell of the unit2. Be aware of internal reactions and judgements--stay neutral and solution-focused3. Be patient. Ask client how things got to this stage and then Listen to what they tell you
STEP: 41. What type of fears are they expressing? What will they need to muster up their motivation?2. Acknowledge small successes3. Make appropriate referrals4. Encourage increased Social contact5. De-Emphasize punishment.
DISCARDING1. Do I need it?2. Have I used it in the last year?3. Select target areas and types of possessions4. Sort into "Yes" and "No" piles5. Work quickly and continuously until target area is clear
DISCARDING6. Most important, plan appropriate use of the cleared area.7. Plan for preventing new clutter to area.8. Cognitive-Behavioral Therapy: Identify self-talk, automatic thoughts and recognize thought patterns9. Always end the session on an "UP" reinforce success and "reward yourself"
HOARDING Self- Directed Program for Hoarding OCDStep 1. Set a Realistic Goal That You are Willing to Achieve – Start SmallStep 2. Make an Assessment of Your Hoarding ProblemStep 3. Put a Moratorium on All AccumulatingStep 4. Develop an Organization Plan for Your HomeStep 5. Decide Where to start FirstStep 6. Establish a Few Simple Rules for Placing, Storing, and Discarding, and Stick to ThemStep 7. Pace YourselfStep 8. When an Area is Clear, Decide How the Space if Going to be Used.
HOARDING KEYS TO BREAKING FREE1.All decisions about saving, discarding, andorganizing are to be made only by the personwith the hoarding problem2.Family members should involve themselvesonly to the extent that they are invited to do soby the hoarder3.During each uncluttering session, stay focusedon one small area until you have completed thearea you started.4.Play soothing, pleasing background music whileuncluttering.5.Severe hoarding should be evaluated by aqualified neurologist or psychiatrist
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(Brief) History of In-Home Counseling• Between 1987 and 1997: • Medicare spending for home care rose at an annual rate of 21 percent • The number of home care agencies certified by Medicare and the number of patients has doubled• The older adult population in the U.S. is increasing annually • “Baby Boomers” HELPHome-based Effective Living Professionals
What is HELP?• HELP (in-Home Effective Living Professionals) • clinical services • county-wide organization • services delivered in homes, offices, or care facilities • especially useful for homebound individuals • services available to individuals of all ages HELPHome-based Effective Living Professionals
HELP Services• Wide array of services • assessment • individual, couples, family counseling and psychotherapy • treatment coordination with case managers, primary care physicians, and other health providers • referrals to community resources HELPHome-based Effective Living Professionals
Clinicians• Services are provided by: • Licensed Clinical Psychologists • Licensed Clinical Social Workers • Marriage and Family Therapists • Bilingual therapists HELPHome-based Effective Living Professionals
Biopsychosocial Assessments• In-home assessments • More thorough assessments possible • Access to important information about living conditions HELPHome-based Effective Living Professionals
Persons Served• Ideal for home-bound patients who otherwiseunable to see a psychologist or physician • frail elderly • people with disabilities • home-bound • seriously ill • agoraphobic HELPHome-based Effective Living Professionals
Patient Characteristics• Treatment duration • usually brief treatment until client regains functioning or transitions to higher level of care• Point-of-entry services • in-home therapists can provide the initial steps to receiving additional community services HELPHome-based Effective Living Professionals
Conditions Treated• Depression • Phobias• Anxiety and Panic Disorder • Anger Management• Agoraphobia • Relationship Issues• Grief and Bereavement • Parenting• Adjustments to Major Life changes• Addictive Behaviors • Step-Family Issues• Mood Disorders • Couples Therapy• Divorce Issues • Family Therapy• Obsessive-Compulsive Disorder • Communication Problems HELPHome-based Effective Living Professionals
Payments• Medicare Part B• Medi-Cal when Medicare is present• Private insurance coverage• Contracts through various social services andprivate agencies• Reasonable private client rates HELPHome-based Effective Living Professionals